Afifi Raafat Y, El-Hindawi Ali A
Department of Surgery and Pathology, Faculty of Medicine, Cairo University, Egypt.
Int J Surg. 2008 Feb;6(1):7-14. doi: 10.1016/j.ijsu.2007.12.002. Epub 2008 Jan 30.
Hyperacute soft tissue infection is an uncommon infectious entity, which mostly affects immunocompromised individuals, mainly diabetics and poses difficult diagnostic and therapeutic management decisions. This study addresses the presentation, evaluation and management of 37 diabetic patients with acute necrotizing fasciitis treated throughout the period between August 1993 and July 2006 by the main author. Extremities, trunk and perineum were the most commonly involved sites with an incidence of 35%, 30% and 27%, respectively. All patients presented with cellulitis, which was associated with oedema in 75.6% of cases, skin gangrene in 59% of cases and brown ecchymotic patches in 30% of cases. Skin vesicles, tenderness and crepitations were present in 13.5%, 11% and 11% of cases, respectively. Streptococci, Staphylococci and E coli were the most commonly encountered organisms, which affected 70% of cases, either alone or in combination. Anaemia and hypoalbuminaemia were the most commonly encountered laboratory findings in 75.6% and 84% of cases, respectively. The mortality rate in the 37 patients included in this study was 43% (16 cases); in 11 of them the infection was located in the trunk and perineum. Once necrotizing fasciitis is suspected, exploration of the fascia is mandatory with pathological assessment of tissue specimens. Radical debridement of the affected area, maintenance of adequate nutritional support and systemic antibiotic therapy should be implemented at once in order to reduce mortality and insure safe recovery of patients.
超急性软组织感染是一种罕见的感染性疾病，主要影响免疫功能低下的个体，以糖尿病患者为主，并且在诊断和治疗管理方面带来了困难的决策。本研究阐述了1993年8月至2006年7月期间由第一作者治疗的37例糖尿病合并急性坏死性筋膜炎患者的临床表现、评估及治疗情况。四肢、躯干和会阴是最常受累的部位，发生率分别为35%、30%和27%。所有患者均表现为蜂窝织炎，75.6%的病例伴有水肿，59%的病例出现皮肤坏疽，30%的病例有褐色瘀斑。皮肤水疱、压痛和捻发音分别出现在13.5%、11%和11%的病例中。链球菌、葡萄球菌和大肠杆菌是最常见的病原体，单独或联合感染了70%的病例。贫血和低白蛋白血症分别是75.6%和84%的病例中最常见的实验室检查结果。本研究纳入的37例患者死亡率为43%（16例）；其中11例感染位于躯干和会阴。一旦怀疑有坏死性筋膜炎，必须探查筋膜并对组织标本进行病理评估。应立即对受影响区域进行彻底清创，维持充足的营养支持并进行全身抗生素治疗，以降低死亡率并确保患者安全康复。
